Most Relevant Information
Provider Data
NPI Number: | 1003510181 |
Provider Name: | QUARTIVIA GIBSON |
Entity Type: | Individual |
Taxonomy Code: | 363LP0808X |
Specialty: | Nurse Practitioner |
License Number: | 905847 |
Most Important Dates
Enumeration Date: | 03/30/2023 |
Last Updated: | 06/09/2023 |
Provider Practice Location
202 GENERAL GARDNER AVE
LAFAYETTE
LA
705017824
Practice Location Phone/Fax
Phone: | 3372329457 |
Fax: |
Provider Mailing Location
5439 BURKHARDT RD
DAYTON
OH
454312111
Provider Mailing Phone/Fax
Phone: | 6019101168 |
Fax: |